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Direct oral anticoagulants versus Vitamin K antagonists for left ventricular thrombus management
No full textBackground: This study compared the rates of intracranial hemorrhage (ICH), ischemic stroke, transient ischemic attack (TIA), and major bleeding events between patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for left ventricular thrombus (LVT) management.
Methods: In this retrospective analysis of claims data, 3152 patients receiving treatment for LVT were identified. Two cohorts were exactly matched on age, sex, and pertinent comorbidities. The primary outcomes were rates of ICH, ischemic stroke, TIA, and major bleeding events between the two groups at 12 months and 24 months. Differences were assessed using the Kaplan-Meier method. Data was analyzed using R (Version 4.1, R Foundation, Vienna, Austria).
Results: 336 patients were compared after the match. The majority were aged between 50-75 (76.2%), were male (80.1%), and had hypertension (77.38%) and hyperlipidemia (66.07%). At 12 months, there were no differences in the rates of ICH (3/168 vs. 2/168, p = 0.7), ischemic stroke (22/168 vs. 15/168, p = 0.2), TIA (9/168 vs 3/168, p = 0.08), or major bleeding events (25/168 vs 35/168, p = 0.1) between DOAC and VKA groups, respectively. Similarly, there were no differences at 24 months in ICH (4/168 vs. 4/168, p = 1), ischemic stroke (26/168 vs. 26/168, p = 0.9), TIA (10/168 vs 4/168, p = 0.1), and major bleeding events (36/168 vs 45/168, p = 0.2) between DOAC and VKA groups, respectively.
Conclusions: DOACs appear to be safe alternatives to VKAs, substantiating their use for LVT management. Further evaluation is nevertheless warranted
International Association of Pancreatology revised guidelines on acute pancreatitis 2025
No full textIntroduction: The International Association of Pancreatology, alongside the American Pancreatic Association, the European Pancreatic Club, the Indian Pancreas Club, and the Japan Pancreas Society, decided to update its earlier guidelines for the management of acute pancreatitis (AP) given the remarkable advances in our understanding of AP and its management over the last decade.
Methods: These organizations put together a group of international experts to address important issues related to the management of AP. Guideline Development Groups comprising international domain experts framed clinically relevant questions and conducted thorough literature searches and systematic reviews to address the questions. Questions were framed in the PICO (Participant, Intervention, Comparator, and Outcome) format where appropriate. The evidence from the literature was synthesized to develop evidence-based recommendations for each question. The quality of evidence and the strength of the recommendations were graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). For some questions, we have provided Good Practice Statements if enough direct evidence was unavailable.
Results: The guidelines pertain to 18 domains comprising 96 questions. The recommendations cover almost all aspects of managing AP, including pain control, fluid therapy, patient stabilization, nutritional support, conservative and interventional treatment for infected necrotizing pancreatitis, management of complications, discharge criteria, guidance on follow-up, and strategies for prevention of recurrence. Specific types of AP, such as those associated with pregnancy, trauma, and metabolic factors have been given special attention.
Conclusion: The recommendations presented here should serve as an evidence-based resource for practicing physicians and caregivers to treat patients with AP more effectively. In addition, the guidelines identify areas for future research, mainly targeted therapies for controlling systemic inflammation and mitigating organ dysfunction
An evidence-based pulsatile tinnitus clinical workflow: A systematic review of literature
No full textIntroduction: Endovascular management options for pulsatile tinnitus (PT) patients have increased in recent years with promising results. However, standardized endovascular team referral criteria remain limited. We conducted a systematic review and suggested an evidence-based referral protocol for PT patients to the neuroendovascular team.
Methods: A literature review was conducted in February 2025 using the PubMed/MEDLINE database. We included English-written studies published in the last 5 years, focusing on PT diagnosis and management. Exclusion criteria included: (1) in vitro or animal studies, (2) studies focused on open surgery approaches, (3) studies addressing only non-PT, and (4) case reports, case series (3-10 cases), commentaries, letters to the editor, editorials, and book chapters.ResultsOur initial search retrieved 257 papers. Of these, 219 were excluded after reading the title and abstract, and an additional 12 were excluded after full-text review. A total of 26 papers were eligible for inclusion in this review and in developing our protocol. After PT diagnosis and imaging, our protocol consists of the following three questions: (1) Is non-invasive imaging suspicious for a dural arteriovenous fistula, high-risk vascular lesions, or idiopathic intracranial hypertension? (2) Despite normal neuroimaging, is there clinical suspicion of a high-risk vascular lesion? (3) Although a low-risk lesion is diagnosed, is PT debilitating? If there is a yes to any of these questions, referral to the endovascular team is recommended.
Conclusion: We suggested an evidence-based referral protocol for PT patients to the neuroendovascular team
BPI25-012: Developing an artificial intelligence tool for personalized breast cancer treatment plans based on the NCCN guidelines
No full textAdvancing a Patient- and Carer-Centered Approach for the Clinical Development of New Therapeutics for Aneurysmal Subarachnoid Hemorrhage: Insights From a Qualitative Study
No full textAneurysmal subarachnoid hemorrhage (aSAH) is characterized by a high rate of fatality and high risk of secondary brain injury. More treatment options are needed to improve outcomes. There are very few reports in the medical literature involving patient experience of aSAH, which is known for its unexpected onset and profound medical impact. Improved understanding of this patient experience would help make future clinical research more patient centered. To this end, we convened an advisory board consisting of aSAH patients and care partners in the United States. Participants emphasized the critical role that care partners play during hospitalization and in accessing supportive resources and rehabilitative care. Recommendations included improving the accessibility of clinical research information during the consent process with sensitivity to the stress and cognitive challenges of patients who have had an aSAH. Participants also recommended prioritizing in-person – either on-site or at-home – as opposed to remote follow-up visits because in-person communication can be easier for those recovering from aSAH. Insights from this study could be invaluable for the clinical development of new therapeutics for aSAH and other acute neurological conditions, with the goal of better meeting the needs of patients and their families during clinical research participation
Trifurcation of the abdominal aorta into one common internal iliac trunk and two external iliac arteries
No full textThis paper describes a novel and previously unreported variation of the aortoiliac arterial tree, discovered incidentally during the angiography of a patient with suspected peripheral arterial disease. The abdominal aorta trifurcated into two external iliac arteries and one common internal iliac trunk, which descended along the midline axis of the abdominal aorta before dividing into two internal iliac arteries. Variations in the aortoiliac division are exceedingly rare, with embryological evidence suggesting that this anomaly may have resulted from the convergence of the umbilical arteries along the midline during later stages of development, after the external iliac arteries had branched off
Identification and validation of a risk assessment scoring tool for extended-spectrum beta-lactamase-producing Enterobacterales bacteremia at a tertiary teaching hospital
No full textObjective:To identify institution-specific risk factors for extended-spectrum beta-lactamase (ESBL) bloodstream infections (BSI) to develop and validate a risk assessment scoring tool that can be utilized for hospitalized patients.
Design:Single-center, retrospective, case-control study.
Setting:Tertiary teaching hospital.
Patients:Hospitalized adult and pediatric patients with E. coli or Klebsiella spp. BSI were stratified based on ESBL production between August 2019 to July 2021. Exclusion criteria included patients \u3c 28 days old, a positive blood culture resulting prior to admission/after discharge or a polymicrobial and/or carbapenem-resistant BSI.
Methods:Multivariable logistic regression assessed predictors of ESBL in a derivation cohort. Predictors were applied to a novel validation BSI cohort using area under the receiver-operator characteristics curve (ROC AUC) to assess the reliability of identifying patients likely to harbor ESBL at the time of organism identification.
Results:A total of 238 patients in the derivation cohort met inclusion criteria stratified as ESBL (n = 68) or non-ESBL (n = 170). Multivariable logistic regression demonstrated diabetes, 30-day history of invasive procedure or antibiotic use, and/or history of ESBL as independent predictors of ESBL. After creation of an ESBL risk assessment tool, the results were applied to a validation cohort of 170 patients. This model displayed good calibration and discrimination with a strong predictive power (Hosmer-Lemeshow χ2= 4.66, p = 0.19; ROC AUC = 0.88, 95% CI = 0.7909 - 0.974).
Conclusions:A validated ESBL risk assessment tool reliably identified hospitalized patients likely to harbor ESBL E. coli or Klebsiella spp. BSI upon organism identification
Totally extravascular bioresorbable closure reduces access complications after endovascular peripheral intervention
No full textObjective: Percutaneous closure of the access artery has become commonplace after endovascular intervention. In patients with peripheral vascular occlusive disease, however, control of the puncture site is more problematic as the access artery is frequently plaque-laden and stenotic. Ischemic complications in the access extremity are more common in these cases, particularly when using devices that depend on the deployment of prosthetic material within the compromised arterial lumen. The purpose of this retrospective clinical study was to assess the efficacy of totally extravascular/bioresorbable closure (TEBC) of the femoral artery puncture sites after percutaneous peripheral intervention (PPI).
Methods: Consecutive PPIs performed at single institution between 2015-2020 were studied. Demographic characteristics and the incidence of access complications were recorded. The complication rate of TEBC and manual compression were analyzed with multivariate regression analysis. Major complications were defined as the composite of acute arterial ischemia, major bleeding and/or pseudoaneurysm requiring operation. Minor complications were defined as the aggregate of transient hypotension, groin hematoma and/or arteriovenous fistula.
Results: A total of 507 PPIs were performed in 345 patients during the study period. The mean age was 74 years; comorbidities were prevalent including diabetes (57%), obesity (28%) and end-stage renal failure requiring dialysis (10%). Indications for PPI were either chronic limb-threatening ischemia (68%) or claudication (32%). All procedures were performed using femoral artery access in a retrograde (93%) or antegrade (7%) fashion with ≤5 Fr (21%), 6 Fr (18%) or ≥7 Fr (61%) sheaths. Control of the femoral artery puncture site was achieved by either manual compression (MC, 75%), or totally extravascular/bioresorbable closure (TEBC, 25%). TEBC became the exclusive closure method in 2019. Acute arterial ischemia rarely complicated MC (1.3%) but was not observed in any patient undergoing TEBC. Bleeding and/or pseudoaneurysms requiring reoperation were also rare (MC 0.3% vs. TEBC 1.6%; p=0.64). On multivariate analysis there was no difference in major access complications between MC and TEBC (OR=1.45 [0.27-7.79]; p=0.66), while minor access complications were significantly reduced with the use of TEBC (OR=0.39 [0.19-0.75]; p
Conclusions: TEBC after PPI for peripheral arterial disease is safe and effective. There were no instances of acute arterial ischemia following TEBC in this series, and TEBC significantly reduced the incidence of minor access complications compared to MC. Given the bioresorbable design of the device, and the lack of an intraluminal component of any kind, TEBC may be the ideal closure device for patients with peripheral arterial disease undergoing endovascular intervention
